Neurosurgery Coding Alert

Question: Our neurosurgeon placed two different cervical plates on a patient's spine. Can I bill 22845 twice with modifier 59 attached?

Texas Subscriber

Answer: If the neurosurgeon uses two separate plates, you can report 22845 (Anterior instrumentation; 2 to 3 vertebral segments) twice. You should append modifier 59 (Distinct procedural service) to the second listing of 22845.

In some cases, you may have to submit your surgeon's documentation to demonstrate that he used two separate plates. Because 22845's descriptor refers to -2 to 3 vertebral segments,- insurers may suspect that your practice erroneously reported two units of 22845 when the surgeon placed a plate that spanned two segments. But you should report this code twice only if the surgeon actually places two separate plates.

Example: The surgeon places a plate that spans from C2 through C4. Levels C5 through L1 are healthy, so the physician does not address them. He then places another plate that spans from L2 through L4. You should report 22845, followed by 22845-59.

Neurosurgeons place spinal plates during surgeries such as anterior discectomy and fusion. The plate helps to ensure that the bone graft remains secure and provides extra stability. This can be done in the front of the spine, in which case the physician generally uses a plate system that screws right into the bone.